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ECG Abnormalities_Part 13

Saturday, November 13, 2010

An 82 year old male with a history of hypertension presents to the clinic with a complaint of generalized weakness for 3 days. No chest pain, shortness of breath, dyspnea on exertion, lower extremity edema, paroxysmal nocturnal dyspnea, orthopnea, palpitations, or dizziness. He takes lisinopril and hydrochlorothiazide for his hypertension.

His temperature is 37.0, blood pressure 100/50 mmHg, heart rate 155 bpm, respiratory rate is 16/min. No jugular venous distension is present, he is tachycardic and irregularly irregular on cardiac exam without any murmurs. His lungs are clear to auscultation. The rest of his exam is normal.

His ECG is below

What Is the Abnormality in this ECG?


The ECG findings include:

1) Atrial fibrillation with rapid ventricular response
2) PVC(Premature ventricular contraction)

Atrial fibrillation occurs when the atrial conduction becomes chaotic and very fast. The atrial rate increases to around 400-600 beats per minute. When this occurs, the amplitude of the P waves markedly decrease. Frequently, the P waves are not able to be detected at all, however at times a coarseness of the baseline of the ECG occurs reflecting the fibrillatory atrial activity. Not all of the 400-600 atrial action potentials per minute are conducted to the ventricles otherwise ventricular fibrillation would occur. Instead, the AV node is able to block a good number of beats usually resulting in a ventricular rate between 120-180 in the absence of AV blocking medications. Due to the chaotic atrial activity, varying block of the atrial action potentials at the AV node occurs resulting in an irregularly irregular rhythm.


35 Responses to ECG Abnormalities_Part 13

  1. Anonymous Says:
  2. extrasystolia

  3. Anonymous Says:
  4. tachicardia sinusale con extrasistole ventricolare

  5. Anonymous Says:
  6. WPW?

  7. Anonymous Says:
  8. Ventricular extrasystole & a.fib ??

  9. Anonymous Says:
  10. AF and 1 VES

  11. Anonymous Says:
  12. WPW?

  13. Anthony Says:
  14. Vent extrasystole and A-fib

  15. Anonymous Says:
  16. a.fib

  17. Anonymous Says:
  18. Atrial fib fvr, occ PVC

  19. Anonymous Says:
  20. Fast AF with PVC

  21. Anonymous Says:
  22. Afib with RVR

  23. Anonymous Says:
  24. atrial fibrillation

  25. jasvinder Says:
  26. left axis deviation, supraventrcular tachycardia, hr 100/ min, ventricular extra systole with right ventricular hypertrophy.

  27. Anonymous Says:
  28. atrial fibrillation with ashmans phenomenon

  29. Anonymous Says:
  30. st dep, svt

  31. Anonymous Says:
  32. A-Fib w/ RVR and aberrancy

  33. Anonymous Says:
  34. atrial fibrilation with ventricular ectopic....

  35. Anonymous Says:
  36. tachicardia sinusale con extrasistole ventricolare

  37. Anonymous Says:
  38. I agree with ashmans phenomenon...

  39. Anonymous Says:
  40. AF

  41. Anonymous Says:
  42. A-Fib w/RVR

  43. Anonymous Says:
  44. I do not believe it to be Ashman phenomenon, as it's not wide. It's not SVT. So it comes down to A-Fib with RVR or WPW syndrome. With the appearent delta waves, I have to go with WPW.

  45. Anonymous Says:
  46. AF, RVH , LAD , for D dimer & mutislice CT for ????? pulmonary embolism

  47. Anonymous Says:
  48. A Fib & PVC

  49. dr baloch Says:
  50. atrial fib with pvc

  51. Anonymous Says:
  52. AF with RVR rare PVC's

  53. Anonymous Says:
  54. atrial fibrilation

  55. Anonymous Says:
  56. I'd say that it is a new onset Atrial Fibrillation with RVR. He does have LAD as someone mentioned above but it is oonlt physiological @ approximately -30 degrees, so it not a concern. Somone else mentioned that the patient may have a PE...maybe, but probably not since he has no SOB. SpO2?? I also see one ventricular ectopic beat.
    I'm a little concerned with the Anteroseptal ST depression seen in V2, V3 and a little V4, also lateral wall extension. It maybe rate dependent so I would slow the rate down with Cardizem @ 0.25mg/kg and then a cardizem gtt @ 5-15mg/Hr. Since it has been 3 days, the patient will have to be anticoagulized with Heparin before cardioversion is attempted (or a TEE).

  57. Anonymous Says:
  58. It's me again. the way.
    A rapid A-Fib with ischemic changes is like a positive stress test without doing anything.....pretty cool huh. Maybe a cardiac cath would also be indicated since he has a positive stress test.

  59. Anonymous Says:
  60. MAT with PVC

  61. Anonymous Says:
  62. mah!! secondo me non scopa piu da tempo ed รจ agitato!!

  63. Anonymous Says:
  64. Ma sente anche sei fischi quanto ciula?

  65. Anonymous Says:
  66. AF cum VES

  67. Anonymous Says:
  68. Af

  69. Hello,

    Healthline just designed a virtual guide of how atrial fibrillation affects the body. You can see the infographic here:

    This is valuable med-reviewed information that can help a person understand the effects of afib of their body. I thought this would be of interest to your audience, and I’m writing to see if you would include this as a resource on your page:

    If you do not believe this would be a good fit for a resource on your site, even sharing this on your social communities would be a great alternative to help get the word out.

    Thanks so much for taking the time to review. Please let me know your thoughts and if I can answer any questions for you.

    All the best,
    Maggie Danhakl • Assistant Marketing Manager
    p: 415-281-3124 f: 415-281-3199

    Healthline • The Power of Intelligent Health
    660 Third Street, San Francisco, CA 94107 | @Healthline | @HealthlineCorp

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